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Table 4 Intervention role expectations and intentions: Description and illustrative quotes

From: An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study

Intervention role expectations/intentions Philosophical views about appropriate ways to intervene Illustrative quotes
Expectations--Outside of Professional Role
Intervention considered outside of the professional role, best addressed through population health approaches
Intentions:
Do not intervene to address lifestyle issues
Population Health Perspective:
Lifestyle behaviours best tackled through addressing underlying determinants of risk taking behaviour
'It wouldn't be us that would be able to take that extra work on...It'd have to be like those ones that do the programs like population [health]Like you people and all that that get funded for these things would have to carry it further.' (Clinician 22)
Expectations--Gatekeeper
Intervention considered outside of scope of professional expertise and job role, best addressed by qualified experts.
Intentions:
Refer clients onwards to qualified experts/specialist service
Medical perspective:
Lifestyle behaviours are complex and require specialist input from qualified experts
It's not my job to get people to quit smokingIf they want to quit smoking I would give them the quit line numberI don't have...those skills...if I was a drug and alcohol worker it'd be a different story, but I'm not.' (Clinician 15)
Expectations--Informer and educator
Ensure client has sufficient information to make an informed choice about lifestyle behaviour. Can only provide intervention to those willing to change.
Intentions
Provide information on health risks/benefits of lifestyle risk factors to all clients. Provide additional assistance to motivated clients.
Individual perspective (individual autonomy and self empowerment):
Lifestyle behaviours are personal choices that people make and as such should be respected. Individuals need to take responsibility for change
'I really leave it up to them--it's their decision what they're going to do, but at least I can give them the information so they can reach a decision whether to keep on smoking or stop.' (Clinician 7)
Expectations- Helper or facilitator
Help move clients towards change over time by acting as a facilitator. Synergistic role with other providers and population health approaches
Intentions:
Facilitate clients to change their behaviour through providing tailored support strategies.
Socio-ecological perspective
Lifestyle habits are complex behaviours influenced by a range of social and environmental factors. Multiple interventions required at individual and population level to effect change.
'If everybody got together and said these risk factors well then people are going to think ...and obviously it's working with the...TV advertising...our smoking rates are going down....' (Clinician 14)